The Roads of Rome for Functional Dyspepsia: From Rome I to Rome V

ABSTRACT Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders. Its diagnostic, classificatory, and therapeutic concepts have continuously evolved alongside successive iterations of the Rome diagnostic criteria, undergoing profound changes over more than three decades. Since the release of Rome I in 1994, the Rome criteria have undergone five major revisions, driving a fundamental shift in the understanding of FD: from a diagnosis of exclusion to a symptom‐based standardized classification and from a “functional disorder” to a disorder of gut–brain interaction. This article systematically reviews the evolutionary course of FD from Rome I to Rome V, compares the core changes in diagnostic definitions, symptom delineation, and subtype classification across different versions of the criteria, analyzes the progression in understanding FD pathogenesis from a single‐factor model to a multifactorial perspective, and summarizes the evolution of treatment strategies, thereby providing a historical perspective and a systematic framework for understanding the conceptual evolution and clinical management of FD. Looking forward, future research should prioritize the identification of validated biomarkers, the development of refined phenotypic stratification, and the generation of real‐world evidence from diverse populations to inform the next iteration of the Rome criteria.